Associations of Reproductive Risk Score and Joint Exposure to Ambient
Air Pollutants with Chronic Obstructive Pulmonary Disease: A cohort
study in UK Biobank
Abstract
Objective: To construct a reproductive risk score (RRS) and an
air pollution score (APS) and assess independent and joint associations
between the two with incident COPD risk. Design:
Population-based prospective cohort study. Setting: UK Biobank.
Population: 78,218 female participants aged 40–69 years
without baseline COPD recruited between 2006 to 2010. Methods:
RRS was constructed by 17 women’s reproductive health-related items, and
APS incorporating PM 2.5, PM 2.5-10, PM
10, NO 2, and NO x was
calculated to assess the joint exposure level. The associations of RRS
and APS with COPD were examined by Cox proportional hazards regression.
Main Outcome Measures: The outcome of the incident COPD was
identified through the in-patient hospital register. Results:
Higher RRS was associated with an increased risk of COPD (adjusted HR:
1.15, 95% CI: 1.12-1.19, P trend < 0.001). A dose-response
manner can be observed between higher quintile APS and increased COPD
risk (P trend < 0.001). The RERI of 0.030 (95% CI:
0.012-0.048) showed additive interaction between RRS and APS on COPD was
significant. In the joint analysis, the combinations of both higher RRS
and APS signified higher incident COPD risk. Conclusions: High
RRS and high APS were associated with increased COPD risks in a
dose-response pattern. Using comprehensive indicators to identify
women’s reproductive risk factors, together with the control of air
pollution, is effective for COPD prevention.